| NPI | 1477633956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00007674) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WA CP00002543) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2008-04-24 |